A New Technique That Complements Sentinel Lymph Node Biopsy: Lymph Node Dissection Under the Intercostobrachial Nerves in Early-Stage Breast Cancer

Because the accuracy of dye tracer is lower than the combined tracer method, in China, where radioactive tracer technique is not widely applied, surgeons need a simple and effective way to assess nodes status. A total of 177 patients with early-stage breast cancer underwent sentinel lymph node biopsy (SLNB), axillary lymph node dissection under the intercostobrachial nerves after SLNB and the axillary lymph node dissection after SLNB separately. The axillary lymph node dissection under the intercostobrachial nerves is a good supplementary procedure to follow SLNB. Background: Arm lymphedema is a common complication after axillary lymph node dissection (ALND), and there is no effective treatment. The clinical significance of sentinel lymph node biopsy (SLNB) is to avoid the risk of arm lymphedema caused by ALND in cases in which the nodes are negative for cancer cells. In developed countries, sentinel lymph node (SLN) localization methods by using combined dye and radioactive tracer techniques predict the lymph node status in early-stage breast cancer with comparable success rates, accuracy, and false-negative rates. In fact, most researchers agree that the combined technique has significantly higher accuracy than marking the sentinel nodes with dye alone. In China, the radioactive tracer technique is mostly used in research but not in clinical surgery, where it is not permitted. The necessity of intercostobrachial nerves (ICBN) preservation is now accepted by the surgeons and has become the standard procedure in such dissections, which reduces postoperative skin numbness and loss of feeling in the upper arm. Methods: In our study, the data of 177 patients were analyzed to identify the feasibility of such an assignment and potential clinical significance of ICBN in dividing the axillary space. Results: We found that the mean value for the number of nodes under the ICBN was enough for accession, the lymphedema caused by axillary lymph nodes dissection under the intercostobrachial nerves (PALND) was similar with SLNB and lower than ALND, and the PALND can make up for SLNB in false negative (SLNs are negative, while non-SLNs are positive). Conclusion: ALND under the ICBN could be considered a procedure complementary to SLNB in early-stage breast cancer in China, where the radioactive tracer technique is not widely applied. (C) 2013 Elsevier Inc. All rights reserved.